Julie LatimerDANA NSW Drug & Alcohol Nurses Forum

September 2014

MSIC provides:A practical and compassionate response to drug injectingSupervision of injecting episodes that might otherwise occur in less safe circumstances such as public places or aloneA safer environment where immediate medical assistance is available if requiredAccess to health & social welfare services for a marginalised & difficult to reach population

Powerful synthetic opioid analgesic 100 times more potent than Morphine Highly lipid soluble = rapid onset Transdermal patch Prescription of fentanyl patches in Australia

has increased dramatically since 2006

First recorded use at MSIC Sept 2012 Higher incidence of overdose compared to

other opioids Increase in use now that new formulation of

Oxycontin (OP) available

High incidence of overdose due to potency Fatalities internationally & nationally Misinformation around dosage Complicated preparation process Tolerance rapidly increases with regular use

Have you used Fentanyl before? Do you know the Oxycontin equivalent of

the patch you have? How do you prepare it for injection? How many 80mg Oxycontin tabs do you

usually use? Have you ever overdosed after using

Fentanyl?

Discussion with clients regarding dose and knowledge base

Increased chance of overdose – may happen quickly

Close observations – 1st 20 mins are important

Clients report effects are not always pleasant

Patch strength Fentanyl content

Approximate Morphine equivalent

Approximate Oxycontin equivalent

100mcg per hour 

16.8mg 1680mg(16.8 x 100mg Morph)

1120mg (14 x 80mg Oxy)

75mcg per hour 

12.6mg 1260mg(12.6 x 100mg Morph)

840mg(10.5 x 80mg Oxy)

50mcg per hour 

8.4mg 840mg(8.4 x 100mg Morph)

560mg (7 x 80mg Oxy)

25mcg per hour 

4.2mg 420mg(4.2 x 100mg Morph)

280mg (3.5 x 80mg Oxy)

12mcg per hour 

2.1mg 210mg(2.1 x 100mg Morph)

140mg (1.75 x 80mg Oxy)

Fentanyl is 100 times more potent than Morphine

Risk of overdose is much higher 1cm square of any strength patch will have

the same amount of Fentanyl on it Find out what the client knows about

Fentanyl